Nurses Burn Out on Long Shifts

Hospital nurses working longer hours were associated with higher levels of burnout, patient dissatisfaction, and safety issues, a study found.

by David Pittman David Pittman Washington Correspondent, MedPage Today
November 08, 2012

Hospital nurses working longer hours were associated with higher levels of burnout, patient dissatisfaction, and safety issues, a study found.

Having nurses work shifts of 13 or more hours was associated with increased patient dissatisfaction, a study published in the November issue of Health Affairs found. Also, nurses working shifts of 10 or more hours were two-and-a-half-times more likely than those working shorter shifts to experience job dissatisfaction and intention to leave the job.

"Our findings contribute to a growing body of research associating nurses' shift length with patient safety issues," Amy Witkoski Stimpfel, research fellow at the University of Pennsylvania School of Nursing, and colleagues wrote. "The results also highlight an area of healthcare ripe for policy development at both national and institutional levels."

Nurses increasingly work 12-hour shifts, providing great flexibility and incentive to enter the profession. But Stimpfel warned hospital nurses must put in unplanned overtime, and that has implications for hospitals and patients.

The researchers used data from 22,275 nurses in the Multi-State Nursing Care and Patient Study who worked at 577 hospitals in four states. The analysis was restricted to nurses on medical or surgical units and in intensive care. Excluded were nurses working in long-term care, outpatient services, or the operating room because they don't usually follow the same shift pattern.

To estimate patient satisfaction, the researchers pooled data from the Hospital Consumer Assessment of Healthcare Providers and Systems survey. That survey was conducted during 2006 and 2007, during the time when the nurses' survey was conducted.

Stimpfel and colleagues looked at shift lengths of 8 to 9 hours, 10 to 11 hours, 12 to 13 hours, and everything greater than 13 hours. Roughly two-thirds of nurses worked shifts of 12 to 13 hours.

The percentage of nurses reporting burnout and an intention to leave the job increased as the shift length increased, the study found. While it was similar for nurses working 8 to 9 hours and 12 to 13 hours, it was higher for nurses working 10 to 11 hours and more than 13 hours.

"Even after we adjusted for potential confounding factors, the significant relationship between longer shift lengths and nurse reports of burnout and job dissatisfaction persisted," the report stated.

Despite literature saying the majority of nurses like 12-hour shifts, their research found they were more likely to leave their job than those who worked shorter shifts. "Nurses underestimate the impact of working long shifts because the idea of working 3 days a week instead of 5 seems appealing," Stimpfel and colleagues wrote.

Researchers found a relationship between shift length and patient satisfaction. When nurses worked shorter shifts, patients were more satisfied.

"We found that seven of the 10 outcomes were significantly and adversely affected by the proportion of nurses in the hospital working shifts of more than 13 hours," the report stated.

Outcomes included patient rating of the hospital overall and whether they would recommend the hospital. Patients expressed the most concern with nurses who worked longer hours by saying they didn't communicate well or explain medications.

Despite poor outcomes associated with longer shifts, most hospitals have moved toward regular use of the 12-hour shift.

Starting next year, hospitals will face reimbursement changes related to achievement of national benchmarks on two global measures of care. "Nurse working conditions, including shift lengths, is one area related to these benchmarks that we believe is readily amenable to change," Stimpfel and colleagues wrote.

The researchers suggested a number of policy changes, including restricting the number of consecutive hours worked. Nursing boards should consider restrictions on shift length and voluntary overtime, they wrote.

Hospitals should be cognizant of nurses' hours worked and second jobs if they have them, they suggested. Leadership should respect nurses' days off and promote prompt departure at the end of a scheduled shift.

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